Consistent with our management practice, October 1, 2018 marked the next scheduled update of the BCBSRI and HIM Health Insurance Marketplace (i.e. direct pay and direct pay through HealthSource RI) Net Results Formularies. This update includes all Commercial segments — fully insured, self-insured, small group with the BCBSRI formulary and individual markets, including the direct pay segments attached to the HIM Net Results Formulary. This update does not involve Medicare programs.

A total of 2,033 members will receive a targeted notification letter. Members will receive one letter per intervention, i.e. tier change, formulary exclusion, brand with generic available. As a result, members may receive more than one letter if they are impacted by more than one targeted intervention. Letters were delivered by September 1, 2018 to allow a 30-day notice prior to the effective date of change.

These updates are reflective of business as usual formulary maintenance and response to changes in the drug marketplace.

This formulary update addresses:

• Brand drugs that have lost patent protection and are now available with generic equivalents.
• Select drugs that have been removed from coverage through the Pharmacy & Therapeutics Committee review process.
• Drugs that have been identified as not meeting benefit eligible requirements, i.e. non FDA-approved or over-the-counter (OTC) available status.
• Select generic drugs that will require a higher copay tier based on escalating costs.

The highest volume of exclusion notifications are associated with products that are available with OTC available options. You may view the updated formulary changes here.